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The term 揷old agglutinin (CA)� refers to a group of disorders caused by anti?erythrocyte autoantibodies that preferentially bind RBCs at cold temperatures (4癈�癈). CAs contribute to 10 to 15% of autoimmune hemolytic anemia. We report a case of CAs diagnosed intraoperatively during emergency mitral valve replacement.
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OBJECTIVES@#To investigate the clinical efficacy of mild therapeutic hypothermia (MTH) with different rewarming time on neonatal hypoxic-ischemic encephalopathy (HIE).@*METHODS@#A prospective study was performed on 101 neonates with HIE who were born and received MTH in Zhongshan Hospital, Xiamen University, from January 2018 to January 2022. These neonates were randomly divided into two groups: MTH1 group (n=50; rewarming for 10 hours at a rate of 0.25°C/h) and MTH2 group (n=51; rewarming for 25 hours at a rate of 0.10°C/h). The clinical features and the clinical efficacy were compared between the two groups. A binary logistic regression analysis was used to identify the factors influencing the occurrence of normal sleep-wake cycle (SWC) on amplitude-integrated electroencephalogram (aEEG) at 25 hours of rewarming.@*RESULTS@#There were no significant differences between the MTH1 and MTH2 groups in gestational age, 5-minute Apgar score, and proportion of neonates with moderate/severe HIE (P>0.05). Compared with the MTH2 group, the MTH1 group tended to have a normal arterial blood pH value at the end of rewarming, a significantly shorter duration of oxygen dependence, a significantly higher proportion of neonates with normal SWC on aEEG at 10 and 25 hours of rewarming, and a significantly higher Neonatal Behavioral Neurological Assessment score on days 5, 12, and 28 after birth (P<0.05), while there was no significant difference in the incidence rate of rewarming-related seizures between the two groups (P>0.05). There were no significant differences between the two groups in the incidence rate of neurological disability at 6 months of age and the score of Bayley Scale of Infant Development at 3 and 6 months of age (P>0.05). The binary logistic regression analysis showed that prolonged rewarming time (25 hours) was not conducive to the occurrence of normal SWC (OR=3.423, 95%CI: 1.237-9.469, P=0.018).@*CONCLUSIONS@#Rewarming for 10 hours has a better short-term clinical efficacy than rewarming for 25 hours. Prolonging rewarming time has limited clinical benefits on neonates with moderate/severe HIE and is not conducive to the occurrence of normal SWC, and therefore, it is not recommended as a routine treatment method.
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Infant, Newborn , Infant , Child , Humans , Child, Preschool , Prospective Studies , Rewarming , Hypoxia-Ischemia, Brain/therapy , Hypothermia, Induced/methods , Treatment Outcome , Electroencephalography/methodsABSTRACT
Objective To investigate the effect of systematic graded rewarming pattern on all-cause mortality of hypothermic trauma patients in different time periods. Methods A prospective case-control study was carried out for 236 hypothermic trauma patients with modified trauma score<12 in the Emergency Department of the Second Affiliated Hospital of Wenzhou Medical University from January 2020 to December 2021.The patients were randomly assigned into a systematic graded rewarming group (n=118) and a traditional rewarming group (n=118).The main outcome event was all-cause death within 15 days after trauma,and the secondary outcome event was all-cause death within 3,7,and 30 days after trauma. Results Overall,13.98%(33/236) and 14.83%(35/236) of the patients died within 15 and 30 days after trauma,respectively,and the median survival time of all dead patients was 6 (4,10) days.The systematic graded rewarming group had higher temperature after rewarming for 2 h (P=0.001) and larger temperature change after rewarming intervention (P=0.047) than the traditional rewarming group.The all-cause mortality within 15 days (27.3%vs.72.7%,P=0.005) and 30 days (25.7%vs.74.3%,P=0.002) in the systematic graded rewarming group was lower than that in the traditional rewarming group.Kaplan-Meier analysis showed that the survival time of the patients in the systematic graded rewarming group was longer than that in the traditional rewarming group (P=0.003).Multivariate cox regression analysis indicated that systematic graded rewarming was a strong protective factor for survival time after trauma (HR=0.450, P=0.042).Further Logistic regression analysis for the occurrence of all-cause death in each time period showed that the OR of systematic graded rewarming pattern to all-cause death within 15 days and 30 days after trauma were 0.289 and 0.286,respectively,after adjusting the covariates(P=0.008,P=0.005).The temperature after rewarming for 2 h had a negative correlation with all-cause mortality within 30 days after trauma (OR=0.670, P=0.049). Conclusions Systematic graded rewarming is a protective factor for the survival time of patients with traumatic hypothermia and an independent factor affecting the risk of all-cause death within 15 days and 30 days after trauma.The temperature after rewarming for 2 h is expected to be an independent predictor of all-cause mortality of 30 days after trauma in the patients with hypothermia.The systematic graded rewarming pattern could reduce the mortality of hypothermic trauma patients.
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Humans , Hypothermia , Rewarming , Case-Control StudiesABSTRACT
@#BACKGROUND: Targeted temperature management (TTM), as a therapeutic temperature control strategy for cardiac arrest (CA), is recommended by guidelines. However, the relationship between post-rewarming fever (PRF) and the prognosis of CA patients is unclear. Therefore, we aim to summarize the studies regarding the influence of PRF on patients with CA. METHODS: EMBASE, PubMed, and Cochrane Central databases were searched from inception to March 13, 2022. Randomized clinical trials (RCTs) and cohort studies on PRF in CA patients were included. According to the heterogeneity, the meta-analysis was performed using a random effects model or fixed effects model to calculate the pooled odds ratios (ORs) and corresponding 95% confidence intervals (CIs). The outcome data were unfavorable neurological outcome and mortality. RESULTS: The meta-analysis included 11 observational studies involving 3,246 patients. The results of the meta-analysis show that PRF (body temperature >38.0 °C) has no effect on the neurological outcome of CA patients (OR 0.71, 95% CI 0.43-1.17, I2 82%) and has a significant relationship with lower mortality (OR 0.63; 95% CI 0.49-0.80, I2 39%). However, PRF with a stricter definition (body temperature >38.5 °C ) was associated with worse neurological outcome (OR 1.44, 95% CI 1.08-1.92, I2 45%) and higher mortality (OR 1.71, 95% CI 1.25-2.35, I2 47%). CONCLUSION: This study suggests that PRF >38.0 °C may not affect the neurological outcome and have a lower mortality in CA patients who completed TTM. However, PRF >38.5 °C is a potential prognostic factor for worse outcomes in CA patients.
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Hypothermia can have adverse effects on various systems of trauma patients, and significantly increase the mortality. All of the current rewarming equipments are contact rewarming equipment, which have the shortcomings of single function and poor effect. The medical staff of the First People's Hospital of Chenzhou designed a multi-functional infrared heating medical rewarming equipment, and obtained the National Utility Model Patent of China (ZL 2018 2 1705172.9). By integrating the infrared heating lamp tube and the air heating device and controlling them independently, the equipment can not only treat the wound by infrared alone, but also keep the wound warm by using the air heating function at low room temperature. In addition, it can also warm the patients with hypothermia separately. The device's dual functions of promoting wound healing and rewarming by infrared therapy and wind-heating are accurate. It is easy to operate with good controllability, and contributes to individualized precision treatment, which is worthy of transformation and promotion.
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High-quality donor organs is of significance for the success of organ transplantation. However, standard donors fail to meet the requirements of kidney transplantation due to the increasing quantity of patients with kidney failure. Marginal donor kidneys have been widely applied in clinical practice, which also poses challenges to the existing preservation methods of donor kidneys. Ischemia-reperfusion injury (IRI) is one of the critical factors affecting the early graft function after kidney transplantation. In addition, it exerts harmful effect upon the long-term survival of the graft. Current studies have demonstrated that hemoglobin-based oxygen carrier (HBOC) may reduce the IRI during kidney transplantation, effectively improve the preservation quality and prolong the preservation time of donor kidney. In this article, the research progress on HBOC in kidney transplantation was reviewed, aiming to provide reference for modifying the preservation method of donor kidney, improve the quality of donor kidney and enhance clinical prognosis of the recipients.
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Objective To study the effect of magnetic rewarming on the morphology and biomechanical properties of vitrified umbilical artery. Methods The vitrified umbilical artery was rewarmed by magnetothermal method and traditional water bath. The temperature distribution and stress in the solution system were analyzed, and the rewarming effect was evaluated by tissue staining and mechanical test. Results Compared with water bath rewarming, the temperature gradient and thermal stress generated by magnetic rewarming were smaller, which could effectively reduce the thermal stress damage during the rewarming stage and achieve rapid and uniform rewarming. Magnetic rewarming could effectively avoid umbilical artery fractures and micro-cracks. After rewarming, the extracellular matrix, collagen fibers, elastic fibers and muscle fibers of the umbilical artery were evenly distributed, which preserved the macro and micro structures of the umbilical artery. The umbilical artery showed different degrees of hardening after water bath and magnetic rewarming, but the elastic modulus and limit stress of the latter were not significantly different from those of fresh umbilical artery, and the latter had unidirectional stretching characteristics similar to that of fresh umbilical artery, showing good elasticity and toughness. Conclusions Compared with water bath rewarming, magnetothermal method can effectively reduce the damage of rewarming stage, ensure the macroscopic, microscopic structure integrity of umbilical artery and better biomechanical properties. The research findings provide important references for cryopreservation of large tissues or organs such as umbilical artery.
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Objective:To observe the effect of systematic graded rewarming measures on body temperature and prognosis of patients with moderate and severe trauma [revised trauma score (RTS) < 12] requiring emergency operation.Methods:A prospective randomized double-blind controlled study was conducted. From January 2020 to January 2021, 104 patients who underwent emergency trauma surgery in the Second Affiliated Hospital of Wenzhou Medical University were selected as the research object. According to random number table method, the patients were divided into traditional rewarming group and systematic graded rewarming group, with 52 cases in each group. Patients in traditional rewarming group (only record the body temperature without intervention, and start the rewarming process when the body temperature at any time was less than 36 ℃); the patients in the system graded rewarming group start the preventive measures as soon as they were admitted to the hospital, and record the body temperature. When the body temperature at any time was less than 36 ℃, start the graded rewarming process. Observe the rewarming effect, coagulation function, blood gas analysis and postoperative anesthesia recovery time of the two groups and final outcome.Results:With the extension of time, the body temperature of the two groups increased gradually. The body temperature of the systematic grade rewarming group was significantly higher than that of the traditional rewarming group at 2 hours after rewarming and at discharge (℃: 36.23±0.77 vs. 35.84±0.93 at 2 hours after rewarming, 36.54±0.87 vs. 35.82±0.92 at discharge, both P < 0.05). The incidence of subsequent hypothermia was significantly lower than that in the traditional rewarming group [7.7% (4/52) vs. 25.0% (13/52), P < 0.05]. The postoperative activated partial thromboplastin time (APTT) of the two groups was significantly shorter than that at admission (s: 35.74±8.05 vs. 45.55±28.02 in the systematic rewarming group, P < 0.05; 38.35±6.48 vs. 42.40±13.18 in the traditional rewarming group, P < 0.05); the intraoperative and postoperative pH values in the systematic rewarming group were significantly higher than those at admission (7.33±0.05, 7.36±0.06 vs. 7.30±0.07, both P < 0.05), while there was no significant difference between the intraoperative and postoperative pH values in the traditional rewarming group and those at admission (7.31±0.06, 7.33±0.06 vs. 7.31±0.05, both P > 0.05). The postoperative prothrombin time (PT) and anesthesia recovery time in the systematic graded rewarming group were significantly shorter than those in the traditional rewarming group [PT (s): 15.05±2.44 vs. 17.94±3.48, anesthesia recovery time (hours): 14.40±11.76 vs. 17.35±10.51, all P < 0.05], and the pH value was significantly higher than that in the traditional rewarming group (7.36±0.06 vs. 7.33±0.06, P < 0.05). The systematic graded rewarming group had higher improvement rate and lower disability rate than the traditional rewarming group (76.9% vs. 65.4% and 17.3% vs. 25.0%, both P < 0.05). Conclusion:Systematic graded rewarming measures can improve the hypothermia of emergency trauma patients who received surgery, reduce the incidence of subsequent hypothermia of trauma patients, shorten the time of postoperative resuscitation, improve the coagulation function and blood gas indexes, improve the treatment rate, and reduce the incidence of disability.
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ABSTRACT BACKGROUND: Postoperative nausea and vomiting (PONV) is a common complication from general anesthesia that impacts on postoperative recovery. OBJECTIVE: To evaluate prophylactic rewarming following general anesthesia, so as to decrease the incidence of PONV among patients undergoing laparoscopic hysterectomy. DESIGN AND SETTING: Prospective randomized clinical study at a hospital in China. METHODS: Sixty-two patients were randomly assigned into two groups. The forced air warming (FAW) group received pre-warmed Ringer's solution with FAW until the end of surgery. The control group received Ringer's solution without FAW. The pre-warmed Ringer's solution was stored in a cabinet set at 40 °C. The FAW tube was placed beside the patient's shoulder with a temperature of 43 °C. RESULTS: Sixty patients completed the study. The FAW group showed significant differences versus the controls regarding temperature. At 6, 24 and 48 hours postoperatively, the incidences of PONV were 53.3%, 6.7% and 3.3% in the FAW group versus 63.3%, 30% and 3.3% in the controls. VAS scores were significantly lower in the FAW group than in the controls at 24 hours (P= 0.035). Forty-item questionnaire total scores in the FAW group were significantly higher than in the controls. The physical independence and pain scores at 24 hours and emotional support and pain scores at 48 hours in the FAW group were higher than in the controls (P < 0.05). There was no difference in hemodynamics or demographics between the two groups (P > 0.05). CONCLUSIONS: Prophylactic rewarming relieved PONV and improved the quality of postoperative recovery. CHINESE CLINICAL TRIAL REGISTER (ChiCTR): ChiCTR-IOR-17012901.
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Humans , Female , Laparoscopy/adverse effects , Rewarming , Postoperative Nausea and Vomiting/prevention & control , Hysterectomy/adverse effects , Hysterectomy/methods , China , Prospective Studies , Treatment OutcomeABSTRACT
OBJECTIVE: Cerebral hemodynamic and metabolic changes may occur during the rewarming phase of targeted temperature management in post cardiac arrest patients. Yet, studies on different rewarming rates and patient outcomes are limited. This study aimed to investigate post cardiac arrest patients who were rewarmed with different rewarming rates after 24 hours of hypothermia and the association of these rates to the neurologic outcomes.METHODS: This study retrospectively investigated post cardiac arrest patients treated with targeted temperature management and rewarmed with rewarming rates of 0.15°C/hr and 0.25°C/hr. The association of the rewarming rate with poor neurologic outcomes (cerebral performance category score, 3 to 5) was investigated.RESULTS: A total of 71 patients were analyzed (0.15°C/hr, n=36; 0.25°C/hr, n=35). In the comparison between 0.15°C/hr and 0.25°C/hr, the poor neurologic outcome did not significantly differ (24 [66.7%] vs. 25 [71.4%], respectively; P=0.66). In the multivariate analysis, the rewarming rate of 0.15°C/hr was not associated with the 1-month neurologic outcome improvement (odds ratio, 0.54; 95% confidence interval, 0.16 to 1.69; P=0.28).CONCLUSION: The rewarming rates of 0.15°C/hr and 0.25°C/hr were not associated with the neurologic outcome difference in post cardiac arrest patients.
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Humans , Critical Care Outcomes , Heart Arrest , Hemodynamics , Hypothermia , Multivariate Analysis , Pilot Projects , Retrospective Studies , RewarmingABSTRACT
Objective To observe the success rate and rewarming curve of different water bath rewarming in rats with severe seawater immersed hypothermia. Methods A total of 490 male SD rats were intraperitoneally implanted with temperature recorder before experiment, were randomly divided into immersion group (n=450) and control group (n=40). In immersion group 100 rats were immersed in (15.0±0.2) °C seawater for 2 h, 150 rats for 5 h, and 200 rats for 10 h. The survival rats of each group were randomly divided into five subgroups and given different rewarming treatments: passive rewarming (passive rewarming subgroup), 37 °C hot water bath rewarming for 0.5 h (37 °C active rewarming 0.5 h subgroup), 37 °C hot water bath rewarming for 1 h (37 °C active rewarming 1 h subgroup), 42 °C hot water bath rewarming for 0.5 h (42 °C active rewarming 0.5 h subgroup), 42 °C hot water bath rewarming for 1 h (42 °C active rewarming 1 h subgroup). The rats in the control group were without seawater immersion, and were randomized into four subgroups as above. The success rate of rewarming was calculated in each group. The serum levels of creatine kinase isoenzyme (CK-MB), alanine aminotransferase (ALT) and lactate dehydrogenase (LDH) were determined in the survival rats after rewarming for 20 h. Dynamic intraperitoneal temperature was recorded at the end of the experiment, and then the passive rewarming velocity, delay afterdrop effect of hot water bath rewarming were calculated. Results With the prolongation of immersing time, the survival rate of rats was significantly decreased in the immersion group (P<0.05). The rewarming success rates were significantly decreased in both the passive and active rewarming groups (both P<0.05). The rewarming success rate in the 37 °C active rewarming 1 h subgroup was greater than or equal to other active rewarming subgroups and the passive rewarming subgroup. All rats in the control group survived after hot water bath. Compared with the control group, the serum levels of CK-MB, ALT and LDH were significantly increased in the surviving rats of the active rewarming subgroups with the prolongation of immersion time (P<0.05). At the same immersing time, the levels of CK-MB, ALT and LDH were significantly lower in the 37 °C active rewarming 1 h subgroup than those in the other active rewarming subgroups (P<0.05 for some results), and were lower than those in the passive rewarming subgroup (P<0.05 for some results). Rewarming curve showed that the rewarming velocity of the passive rewarming subgroup significantly decreased with the prolongation of immersing time (P<0.05), and the rewarming velocity of the dead rats was significantly lower than that of the surviving rats (P<0.05). Delayed afterdrop effect was found in abdominal temperature of hot water rewarming rats, and the greater the effect was, the higher the mortality rate was. The delayed afterdrop effect of 37 °C hot water bath was not obvious in the control group, but it was significantly obvious in 42 °C hot water bath subgroups (P<0.05). Conclusion The success rate of proper hot water bath rewarming is greater than that of passive rewarming in the treatment of severe seawater immersed hypothermia. Hot water bath can be used as a rewarming option in emergency situations, while improper rewarming conditions can decrease the treatment success rate, which may be related to the delayed afterdrop effect.
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Objective To explore the effects of heating intravenous fluid infusion and blood transfusion based on guidelines in severe trauma patients with hypothermia. Methods A total of 40 severe trauma patients with hypothermia admitted from July 2014 to December 2015 were enrolled as the control group treated with routine measures to maintain the body temperature at normothermia by such as electrical heating blanket; other 40 severe casualties with hypothermia admitted from January 2016 to July 2017 were recruited as the warming up group treated with heating intravenous fluid infusion and blood transfusion by hot water bath in addition to the routine measures for keeping body temperature at normothermia. The differences in core body temperature, prothrombin time, activated partial thromboplastin time, incidence of shivering and mortality rate were compared between the two groups. Results There was statistically signifi cant difference in core body temperature at 0.5 h, 1.0 h, 1.5 h, 3.0 h between the two groups (P<0.05). Though the prothrombin time and shivering were improved after warming up in both groups, and there were significant differences in prothrombin time at 3.0 h after warming up and the incidence of shivering between two groups(P<0.05).There was no signifi cant difference in mean arterial pressure at all seven intervals between two groups. Conclusion The heating intravenous fl uid infusion and blood transfusion had remarkable effects to prevent hypothermia, improves blood coagulation and reduced the incidence of shivering to provide more simple and convenient warming up intervention for clinical practice.
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This article summarized the evidence-based nursing program of rewarming in 41 adult patients with traumatic hypothermia.According to the principle of PICO,the clinical problems were clarified.The related literatures were collected through searching the databases of Cochrane Library,EMBASE,CINAHL,PubMed,CBM,CNKI,VIP Resource Library and Wanfang Database,and were evaluated.The evidence-based nursing program of rewarming was formulated,including the establishment and implementation of rewarming standards,clinical application of rewarming,and continuous monitoring of rewarming process.A total of 41 adult patients with traumatic hypothermia were applied with evidence-based nursing program,and achieved satisfactory results.The evidence-based nursing program of rewarming improved standards of clinical nursing practice,and promoted nurses' professional capacity as well as quality of clinical specialty nursing.
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OBJECTIVE: To analyze the changes of finger skin temperature in cold provocation test( CPT) in workers with vibration white finger( VWF). METHODS: A total of 245 male workers engaged in hand arm vibration operation was selected as study subjects using random number table method. All subjects were divided into VWF group( 73 persons) and control group( 172 persons). CPT( 10 ℃,10 min) was performed and the skin temperature of 6 fingers( index finger,middle finger and ring finger of both hands) was measured at pre-CPT adaptation period( 0,10,20,30 min) and after CPT period( 0,5,10,15,20,25,30 min). RESULTS: The effect of interaction between grouping and observe time was statistically significant on finger skin temperature( P < 0. 01). In the pre-CPT adaptation period,there was no statistically significant difference on skin temperature between 10 and 30 min time point in the two groups( P > 0. 05). After CPT,the fingers skin temperature of VWF group was lower than that of control group at 5 min time point( P < 0. 05),but there were no statistically significant differences on fingers skin temperature of other time points between the two groups( P > 0. 05).In both groups,the finger skin temperature at 0 min time point after CPT were lower than other time points in the same group( P < 0. 05),and the finger skin temperature increased with time( P < 0. 01). However,the finger skin temperature at 30 min after CPT did not restore to that at 30 min time point of pre-CPT. Except the VWF group,the abnormal rewarming temperature at 5 min time point after CPT of left index finger,the right index finger and the right ring finger were higher than that of the control group( 72. 6% vs 56. 4%,75. 3% vs 57. 6%,86. 3% vs 65. 1%,P < 0. 05),but there were no statistically significant differences on the abnormal rewarming temperature at 10,30 min time points of the six fingers in the two groups( P > 0. 05). There were no statistically significant differences on the detection rate of abnormal rewarming temperature between left index finger and the right index finger,or the right index finger and the right ring finger in the VWF group( 72. 6% vs 75. 3%,75. 3% vs 86. 3%,P > 0. 05). CONCLUSION: When CPT( 10 ℃,10 min) was performed in workers engaged in hand arm vibration operation,it is recommended to measure the finger skin temperature of index finger,and adaptation time before CPT can be adjusted to 10 min.
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Objective To determine the effects of nitroglycerine on cooling and rewarming during cardiopulmonary bypass with deep hypothermic circulatory arrest (DHCAC).Methods Forty-six patients undergoing total aortic arch replacement with DHCAC, 38 males and 8 females, aged 26-74 years, falling into ASA physical status Ⅳ or Ⅴ, were randomly assigned to study group (n=24) and control group (n=22).The same cooling and rewarming methods were implemented in both groups.During cooling and rewarming, the study group received nitroglycerine infusion and the control group normal saline of same volume.The rectum rewarming time, the nasopharyngeal cooling and rewarming time were measured and compared.Results The time of rewarming rectum was significantly shorter in the study group compared to the control group [(104±30) min vs (127±31) min, P<0.05].There was no difference in cooling time , time of rewarming nasopharynx.Conclusion Nitroglycerine shortens the time of rewarming rectum during cardiopulmonary bypass with deep hypothermic circulatory arrest.
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Therapeutic hypothermia (TH) improves the neurological outcome in patients after cardiac arrest and neonatal hypoxic brain injury. We studied the safety and feasibility of mild TH in patients with poor-grade subarachnoid hemorrhage (SAH) after successful treatment. Patients were allocated randomly to either the TH group (34.5°C) or control group after successful clipping or coil embolization. Eleven patients received TH for 48 hours followed by 48 hours of slow rewarming. Vasospasm, delayed cerebral ischemia (DCI), functional outcome, mortality, and safety profiles were compared between groups. We enrolled 22 patients with poor-grade SAH (Hunt & Hess Scale 4, 5 and modified Fisher Scale 3, 4). In the TH group, 10 of 11 (90.9%) patients had a core body temperature of 95% of the 48-hour treatment period. Fewer patients in the TH than control group (n = 11, each) had symptomatic vasospasms (18.1% vs. 36.4%, respectively) and DCI (36.3% vs. 45.6%, respectively), but these differences were not statistically significant. At 3 months, 54.5% of the TH group had a good-to-moderate functional outcome (0–3 on the modified Rankin Scale [mRS]) compared with 9.0% in the control group (P = 0.089). Mortality at 1 month was 36.3% in the control group compared with 0.0% in the TH group (P = 0.090). Mild TH is feasible and can be safely used in patients with poor-grade SAH. Additionally, it may reduce the risk of vasospasm and DCI, improving the functional outcomes and reducing mortality. A larger randomized controlled trial is warranted.
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Humans , Aneurysm , Body Temperature , Brain Injuries , Brain Ischemia , Embolization, Therapeutic , Heart Arrest , Hypothermia, Induced , Mortality , Pilot Projects , Prospective Studies , Rewarming , Subarachnoid Hemorrhage , Vasospasm, IntracranialABSTRACT
Accidental hypothermia refers to a state of lowering of core body temperature down to 35 °C induced by drowning, burial in snow and prolonged exposure to cold environment, etc. Hypothermia may affect the cardiovascular system, respiratory system, digestive system, etc. The triad consisting "hypothermia, acidosis and coagulopathy" is an important factor accelerating the death of patients. Early, timely application of rewarming measures is regarded as the basic principle in treatment of hypothermia. A series of rewarming measures, such as infusion of warm fluids, inspiration of warm air, abdominal infusion of warm fluid, instruction of warm fluid into pleural cavity, intravenous infusion of warm fluid, rewarming through ECMO, etc. have been used recently. Advance in research on the classification of hypothermia, its impact to the body and the treatment methods are reviewed in present paper.
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Objective To evaluate the rewarming and?anesthetic recovery regularity in different body mass index(BMI) patients with primary liver cancer by the same rewarming measures. Methods The data of 67 primary liver cancer patients with hypothermia after surgery were analyzed retrospectively and divided into three groups (low BMI group:BMI<18.50 kg/m2,normal BMI group: BMI 18.50-22.99 kg/m2, and high BMI group: BMI≥23.00 kg/m2) according to the standard of Asian BMI. Rewarming time and speed, spontaneous breathing recovery time,waking time and shivers in the three groups were observed and compared. Results Rewarming time, spontaneous breathing recovery time,waking time were (114.75± 21.91), (62.60±23.47), (94.65±20.54) min in low BMI group, (93.46±30.39), (41.19±21.47), (66.11±24.78) min in normal BMI group and (61.43±16.37), (25.81±8.90), (50.57±10.41) min in high BMI group,there were significant differences among three groups (F=25.300, 18.962, 25.647, all P<0.05). Rewarming speed was (0.85±0.13) ℃/h in high BMI group, (0.44±0.10) ℃/h in normal BMI group, (0.47±0.16) ℃/h in low BMI group,there were significant differences among three groups(F=65.810, P<0.05). Conclusions Rewarming for a long time in the primary liver cancer patients with low BMI and hypothermia after surgery by the same measures.More attentions should be paid to management of low BMI patients in the rewarming process, and aggressive measures should be taken to restore body temperature to normal.
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Hypothermia, defined as an unintentional decline in the core body temperature to below 35degrees C, is a life-threatening condition. Patients with malnutrition and diabetes mellitus as well as those of advanced age are at high risk for accidental hypothermia. Due to the high mortality rates of accidental hypothermia, proper management is critical for the wellbeing of patients. Accidental hypothermia was reported to be associated with acute kidney injury (AKI) in over 40% of cases. Although the pathogenesis remains to be elucidated, vasoconstriction and ischemia in the kidney were considered to be the main mechanisms involved. Cases of AKI associated with hypothermia have been reported worldwide, but there have been few reports of hypothermia-induced AKI in Korea. Here, we present a case of hypothermia-induced AKI that was treated successfully with rewarming and supportive care.
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Aged , Humans , Male , Acute Kidney Injury/etiology , Hypothermia/complications , RewarmingABSTRACT
BACKGROUND: Rapid fluid warming has been a cardinal measure to maintain normothermia during fluid resuscitation of hypovolemic patients. A previous laboratory simulation study with different fluid infusion rates showed that a fluid warmer using magnetic induction is superior to a warmer using countercurrent heat exchange. We tested whether the simulation-based result is translated into the clinical liver transplantation. METHODS: Two hundred twenty recipients who underwent living donor liver transplantation between April 2009 and October 2011 were initially screened. Seventeen recipients given a magnetic induction warmer (FMS2000) were matched 1 : 1 with those given a countercurrent heat exchange warmer (Level-1 H-1000) based on propensity score. Matched variables included age, gender, body mass index, model for end-stage liver disease score, graft size and time under anesthesia. Core temperatures were taken at predetermined time points. RESULTS: Level-1 and FMS groups had comparable core temperature throughout the surgery from skin incision, the beginning/end of the anhepatic phase to skin closure. (P = 0.165, repeated measures ANOVA). The degree of core temperature changes within the dissection, anhepatic and postreperfusion phase were also comparable between the two groups. The minimum intraoperative core temperature was also comparable (Level 1, 35.6degrees C vs. FMS, 35.4degrees C, P = 0.122). CONCLUSIONS: A countercurrent heat exchange warmer and magnetic induction warmer displayed comparable function regarding the maintenance of core temperature and prevention of hypothermia during living donor liver transplantation. The applicability of the two devices in liver transplantation needs to be evaluated in various populations and clinical settings.